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>But is the market free? IMO, it's very much controlled by those who wield a heavier wallet - the big pharma, the insurers, the big hospitals, the ambulance chasers.

Actually, it's simpler than that.
The insurers have an incentive to spend as much as they can on claims, because their premiums are based on claims paid, and they are allowed to maintain a margin that is expressed as a percentage of premiums.
The math is simple- the more claims they pay, the more profits they make.
MD's have the same incentive to maximize claims.
The patient has been bamboozled into thinking that needless tests and drugs equate to quality care and becomes an accessory by going along with the spiral.
When the ACA suggested that groups be formed to decide which therapies are needed the insurer and MD lobbies quickly labelled them "death panels."
The answer is pretty simple.
Eliminate insurers and go to a single payor plan like Medicare, which has the reverse incentive.